Spanish for interventional radiology nurses: the patient who expected general anesthesia for his TIPS procedure and did not understand what conscious sedation meant, the patient whose arteriovenous fistula is three weeks old and who has been protecting it so carefully she has not done a single compression exercise, and the patient six hours post-embolization rating her pain as four when it is eight because she is afraid of being admitted overnight

Antonio Reyes had been preparing for the procedure for two weeks the way a retired bus driver prepares for anything: methodically. He had cleared his schedule. He had arranged for his daughter to drive him home. He had not eaten since midnight. He had told his wife what to expect, based on what he had been told: they were going to sedate him, go in through his neck, and do something with the veins in his liver that would stop the bleeding. He would be asleep. He would not feel it. He would wake up when it was over.

He was fifty-eight years old, a retired bus driver from Fresno, a man with cirrhosis from hepatitis C that had been quiet for years until it was not. He had been in the hospital twice in the last four months for esophageal variceal bleeding — the kind that fills a basin, that sends everyone in the room moving very quickly. He had been told a TIPS procedure would reduce the pressure in the veins and make the bleeding less likely. He had said yes. He had signed the consent. He was ready.

He was not ready for what sedation actually meant.

He knew what anesthesia felt like. Five years ago, a total knee replacement: the anesthesiologist counting backward, and then nothing, and then a recovery room, and his daughter’s face, and he had not felt the procedure at all. He had mapped that experience onto the word sedación and arrived at the interventional radiology suite in the calm of a man who believes he will be unconscious in fifteen minutes.

Three interventional radiology patterns that arrive in the pre-procedure suite and the recovery bay as “pensé que me iban a dormir completamente,” and “no he hecho los ejercicios porque tengo miedo de dañar el acceso,” and “estoy bien, de verdad” from a patient who has not moved in six hours and is breathing in careful, shallow increments: Antonio Reyes, fifty-eight, a retired bus driver from Fresno with decompensated cirrhosis scheduled for a transjugular intrahepatic portosystemic shunt (TIPS), who understood “sedación” through the frame of the general anesthesia he received for his knee replacement and is now learning, in the pre-procedure bay, that he will be awake enough to breathe on his own and feel pressure and movement throughout the procedure; Carmen Vargas, sixty-five, a retired seamstress from Phoenix with end-stage renal disease whose left forearm arteriovenous fistula was placed three weeks ago and whose first dialysis session is in six days, who understood “protéjalo” as a complete prohibition on using the arm for anything and has not done a single compression exercise because she believed exercises would damage the access she was protecting; and Elena Torres, forty-four, a dental hygienist from Albuquerque who had a uterine fibroid embolization seven hours ago for symptomatic fibroids she has been managing entirely alone, who has given the same answer at every pain check — “cuatro,” “cuatro,” “cuatro” — while the IR nurse notices she has not moved her body in seven hours and is taking the shallowest breaths the nurse has seen all day.

The patient who expected to be fully unconscious and arrived to learn that TIPS uses conscious sedation

The IR nurse came into the pre-procedure bay to do the pre-procedure assessment and found Antonio sitting upright in the bed, fully dressed from the waist up, with a look she had learned to read over years in the suite: not anxiety, exactly, but a particular quality of readiness that belongs to people who have built a plan and are holding it.

She introduced herself, confirmed his name and date of birth, and asked him what he understood about what was going to happen today. It was a routine question. The answers were rarely routine.

“Tengo entendido que van a sedarm e, que van a entrar por el cuello, y que van a hacer algo con las venas del hígado para bajar la presión. Que voy a estar dormido y no voy a sentir nada.”

She noted the last sentence. She asked him what experience he had had with anesthesia before.

“La rodilla, hace cinco años. Me contaron hasta diez y no recuerdo nada más. Me desperté y ya estaba terminado.”

She sat down so they were at eye level. She had given this explanation many times and had learned that rushing it produced a patient who nodded without understanding and then, somewhere in the middle of the procedure, felt the catheter move through his hepatic vein and arrived at a kind of panicked confusion that was much harder to manage than a clear conversation before the first needle.

“Señor Reyes, me alegra que me lo haya dicho, porque necesito explicarle algo importante antes de empezar. Lo que usted describió de la rodilla — ese estado de no recordar nada, de dormirse antes de empezar — se llama anestesia general. Con la anestesia general, el anestesiólogo controla la respiración con una máquina porque el medicamento lo deja tan profundamente dormido que el cuerpo no respira solo. Eso es una cosa. Para este procedimiento vamos a usar algo diferente, que se llama sedación consciente. Con la sedación consciente, el medicamento lo va a relajar muy profundamente — la mayoría de nuestros pacientes no recuerdan el procedimiento, o lo recuerdan como algo muy lejano. Pero su cuerpo va a seguir respirando solo, y usted va a estar en un estado en el que, si le hablo, puede responder.”

Antonio was quiet for a moment.

“¿O sea que voy a estar despierto?”

“No va a estar despierto como está ahora mismo — va a estar muy, muy relajado, y la mayoría de las personas en ese estado no tienen ningún recuerdo. Pero no es el mismo estado que la anestesia de la rodilla. Y quiero prepararle para las sensaciones que puede notar durante el procedimiento, para que no lo sorprendan.”

She explained what most patients feel during TIPS under conscious sedation: pressure in the neck when the introducer sheath is placed in the jugular vein; a sensation of movement and fullness when the catheter advances through the right heart and into the hepatic vein; pressure again when the stent is deployed. Not sharp pain for most patients — the sedation manages that — but a physical awareness that something is happening inside his body that he would not have if the procedure had used general anesthesia.

“La sensación que más describen los pacientes es presión — especialmente en el cuello al principio, y después una sensación de movimiento o de plenitud cuando trabajamos dentro del hígado. No es dolor agudo para la mayoría de las personas con la sedación que le vamos a dar. Pero si en algún momento siente algo que le molesta mucho, hay una enfermera a su lado durante todo el procedimiento. No va a estar solo, y podemos ajustar el medicamento.”

She gave him a signal to use if he could not speak: two fingers raised.

“¿Tiene preguntas sobre esto antes de empezar?”

Antonio looked at his hands. He was a man who had driven a bus for thirty-one years through the Central Valley, who had managed diesel breakdowns in July heat and passengers in various states of distress, who had developed a particular relationship with unexpected situations: not fear, but a need to understand what was actually about to happen before it happened.

“Sí,” he said. “¿Cuánto tiempo va a durar?”

She told him: typically sixty to ninety minutes for the procedure itself, depending on the anatomy; a few hours of recovery in the bay afterward. He asked three more questions — about the sheath in his neck, about what the stent would feel like when it was in, about whether he would know when it was over. She answered each one. By the time the transport team came to bring him into the suite, the readiness in his face had changed quality: still present, but resting on information rather than assumption.

He was in the suite for seventy-two minutes. The stent was placed without complications. In the recovery bay, he told the nurse that he remembered something that felt like someone pressing on his neck, and then something that felt like fullness in his chest, and then he was looking at the ceiling with a blanket on him and it was over.

“No fue tan malo,” he said. “Si me lo hubieran explicado así antes, no me hubiera preocupado como me preocupé.”

The IR pre-procedure team updated their Spanish-language pre-procedure call script to add a specific line distinguishing sedation from general anesthesia, with an example from common surgical experience. They had been giving the same one-sentence description of “sedation” for six years. Antonio was the fourth patient in two months who had arrived expecting something that was not what they had planned.

The patient who protected her arteriovenous fistula so carefully that she did not do the exercises, and the fistula did not mature

Carmen Vargas arrived at the vascular access maturation check three weeks after her AV fistula creation with her left arm wrapped in a knit sleeve she had found at a craft fair, held slightly away from her body the way a person holds an arm after a recent fracture, with a care that had the quality of something maintained at constant effort.

She was sixty-five years old, a retired seamstress from Phoenix, a woman who had spent four decades doing precise things with her hands and who approached her fistula care with the same precision she had brought to her work: she had a routine, she had followed it exactly, she had not deviated from it once in twenty-one days. No sleeping on that arm. No blood pressure on that arm. No blood draws from that arm. No carrying. No lifting. No impact. She had been told to protect the fistula and she had protected it.

The vascular access nurse palpated the left forearm. The anastomosis was patent — she could feel the thrill, the vibration of blood moving through the connection. But the cephalic vein proximal to the anastomosis was not what she expected to feel at three weeks. It should have been firmer, fuller, more dilated from three weeks of use. It felt like a vein that had not been asked to do anything.

She asked Carmen to describe her exercise routine.

Carmen blinked. “¿Qué ejercicios?”

The nurse asked her what she had been given at discharge after the fistula creation surgery. Carmen produced a discharge sheet — in English — that listed wound care, activity restrictions, and follow-up instructions. The compression exercise instructions were three lines at the bottom of the page, in a font smaller than the rest. In English.

“Me dijeron que lo protegiera. Eso sí lo entendí. Y eso es lo que he hecho — no lo he tocado, no he puesto nada sobre ese brazo, no he usado esa mano para nada. ¿Eso no era lo que había que hacer?”

The nurse took a breath. Carmen had done exactly what she understood she had been asked to do. The protection she had applied — the sleeve, the positioning, the avoidance — was entirely correct. What had not been communicated, in language she could access, was the second half of what the fistula needed: the exercises that create the flow stimulus that tells the vein to remodel into the outflow track that dialysis requires.

“Señora Vargas, todo lo que ha estado haciendo — no dormir sobre ese brazo, no dejar que le tomen la presión, no cargar cosas con esa mano — eso es exactamente correcto, y lo va a seguir haciendo. No hizo nada mal. Lo que pasó es que las instrucciones que le dieron no estaban completas — les faltó explicarle la parte de los ejercicios, y eso es algo que nosotros necesitamos mejorar.”

She let that sit for a moment before continuing.

“El acceso tiene dos necesidades que pueden parecer opuestas pero no lo son. Necesita protección de presión externa — eso es lo que usted ha estado haciendo. Y necesita flujo de sangre interno — eso es lo que hacen los ejercicios. La vena necesita que la sangre pase por ella con fuerza para recibir la señal de que tiene que crecer y hacerse más gruesa. Si no hay flujo, la vena no recibe esa señal, y el acceso no madura lo suficiente para usarse en diálisis.”

Carmen was looking at her arm differently now. Three weeks of meticulous protection. She had not understood that the same arm she was protecting also needed to be used.

“¿Y si lo ejercito ahora, se puede recuperar?”

The honest answer was: probably, but the timeline was going to be tight. First dialysis was scheduled in six days. Whether the fistula would be mature enough to cannulate in six days depended on how it responded to three weeks of missed exercise in six days of intensive use, and that was not something the nurse could promise. She was honest about it.

“Lo que sí puedo decirle es que empezar ahora es mucho mejor que no empezar. Y vamos a ver cómo responde en los próximos días. Si el acceso no está listo para el primer día de diálisis, hay opciones temporales — no es el fin del proceso. Pero empecemos los ejercicios ahora mismo, hoy.”

She demonstrated the compression exercise: a foam ball in the hand, squeeze and release at a steady pace, ten repetitions, three times a day, after five minutes of warming the arm in a sink of comfortably warm water. She had Carmen do the first set while she watched. She showed her where to feel for the thrill after each set — the vibration just distal to the anastomosis that confirmed the fistula was patent and flowing.

“¿Siente eso? El zumbidito, la vibración?”

Carmen pressed two fingers to her own forearm, concentrating. Then: “Sí. Como agua que fluye por dentro.”

“Exactamente. Eso es la señal de que el acceso está funcionando. Si alguna vez ese zumbido no se siente, llame de inmediato — eso sí es una emergencia. Pero si está ahí, y usted sigue con los ejercicios, el acceso sabe qué hacer.”

Carmen left with a Spanish-language instruction sheet, a foam ball, a list of the warning signs that would require immediate contact, and the direct number for the vascular access clinic. She called at forty-eight hours to report that the arm felt warmer after the exercises and the vibration was stronger than before. At the six-day check, the cephalic vein had changed substantially. The access was used at the first dialysis session without difficulty.

The Spanish-language discharge instructions from the fistula creation unit were revised to separate protection requirements from exercise requirements into two distinct sections with a subheading that read, explicitly: “Proteger el acceso Y ejercitarlo son dos cosas diferentes — el acceso necesita las dos.”

The patient six hours post uterine fibroid embolization who has been rating her pain as four when the nurse suspects it is much higher

Elena Torres had been managing her fibroids alone for two and a half years. Not alone in the sense of having no care — she had a gynecologist she saw annually, she had the procedure scheduled with a referral, she had been to the pre-procedure appointment and signed the consent. Alone in the sense of having told no one in her life that she was having it.

Her employer believed she was taking two personal days for a family matter. Her husband believed she was at a dental continuing education conference in Albuquerque — she had invented this, had registered for a conference that did not start until next month, had mentioned the dates at dinner three weeks ago in the casual way of someone announcing something unremarkable. She had fibroids that had grown for two years and had been causing bleeding that she managed with supplies she ordered online and changed in the bathroom at work. She had made a plan, she had executed it, and she needed to be discharged by five o’clock tonight in order for the plan to hold.

It was twelve thirty in the afternoon. She was seven hours post procedure. Her pain score at the two-hour check had been four. Her pain score at the four-hour check had been four. Her pain score now, at the IR nurse’s seven-hour check, was four.

The IR nurse had been doing post-procedure recovery for eleven years. She had seen post-embolization syndrome many times: the cramping that begins when the uterine arteries close and the fibroids begin to infarct, the low-grade fever, the fatigue, the nausea. She had also seen patients whose pain was much higher than what they were reporting. Elena had not shifted her body position in seven hours. Her respiratory rate was sixteen but they were the shallowest sixteen breaths the nurse had counted today. Her blood pressure, which had been 118/74 at baseline, was 138/88 now.

The nurse pulled her chair to the bedside and sat down.

“Señora Torres, antes de preguntarle el número del dolor — quiero decirle algo primero. El número que me dé no determina automáticamente si se va a casa hoy o si se queda. Lo que determina eso es si su dolor está controlado con la medicación que tenemos disponible. Si me da el número real, yo puedo asegurarme de darle el medicamento correcto para ese nivel de dolor. Si me da un número más bajo para irse antes, puede que el medicamento que le dé no sea suficiente, y el dolor en casa va a ser peor — y no va a tener forma de manejarlo sin llamarnos o ir a urgencias.”

Elena was looking at the ceiling. She did not say anything for a moment.

“Ahora sí — ¿cuánto le duele ahora mismo, con el respiro que está tomando en este momento?”

A long pause.

“Ocho.”

The nurse did not change her expression. She asked Elena to describe where the pain was.

“Es un cólico — como cólicos menstruales pero mucho más fuertes. En el bajo vientre. Y a veces en la espalda. Cuando respiro hondo, empeora. Por eso no he respirado hondo.”

The nurse noted this in the chart. Post-embolization ischemic cramping, as expected, but undertreated from inadequate pain reporting. The ketorolac and hydromorphone Elena had received at two hours and four hours had been dosed for the four she reported; the regimen for an eight was different.

“¿Hay algo que le preocupe sobre quedarse aquí más tiempo? Porque me da la impresión de que tiene algo que necesita hacer hoy.”

Elena looked at her for the first time in the conversation. The nurse had not said it as an accusation. She had said it with the neutrality of someone stating an observation.

“Tengo que estar en casa a las cinco.”

“¿Por qué a las cinco?”

Elena explained it simply: no one knew she was here. She had planned for a same-day discharge. She needed to be home before her husband.

The nurse did not ask why she had kept it private. That was Elena’s decision to make. What the nurse needed to address was the medical situation in front of her: a patient with eight-out-of-ten pain at seven hours post-procedure who had been receiving pain management calibrated for four, and who needed to make a discharge decision based on adequate treatment, not on a plan built around a number she had invented.

“Lo que necesito que sepa es esto: el dolor que siente ahora — ocho — es tratable. Tenemos medicamentos que podemos darle en la próxima hora que deberían bajar ese ocho a algo manejable. Lo que no puedo hacer es dejarla irse con un dolor de ocho con el medicamento equivocado, porque en casa, cuando ese medicamento se acabe, el dolor va a estar disponible completo. Y va a estar sola.”

Elena was quiet.

“Déjeme hacer el trabajo correcto en la próxima hora. Si el dolor baja a algo manejable — un cuatro real, no uno inventado — y sus signos vitales están donde deben estar, usted se puede ir a las cinco. ¿Podemos intentar eso?”

“Sí.”

The revised pain management brought Elena’s self-reported pain from eight to three and a half over the following ninety minutes. Her respiratory rate deepened. Her blood pressure came down. She asked for water. She moved her legs.

She was discharged at four fifty with an adequate analgesic regimen, Spanish-language discharge instructions that included the specific signs of post-embolization syndrome that should prompt a call to the clinic versus an emergency department visit, and a direct number for the IR recovery line.

The nurse did not ask what Elena told her husband when she got home. That was not the nurse’s part. Her part was to make sure Elena arrived home with pain that would not overwhelm what she was carrying.

Spanish vocabulary for interventional radiology: the terms you need for procedures, sedation, access, and recovery

TIPS (transjugular intrahepatic portosystemic shunt): “derivación portosistémica intrahepática transyugular,” “el procedimiento del hígado,” “la comunicación entre las venas del hígado.” Patients say “el procedimiento del cuello” when they remember the access site. Portal hypertension: “hipertensión portal,” “la presión alta en las venas del hígado.” Esophageal varices: “várices esofágicas,” “venas dilatadas en el esófago que pueden sangrar.” Cirrhosis: “cirrosis,” “cicatrización del hígado.”

Conscious sedation: “sedación consciente,” “sedación moderada,” “el medicamento para relajarlo que no lo duerme completamente” — “va a estar muy relajado pero su cuerpo va a seguir respirando solo.” General anesthesia: “anestesia general,” “anestesia completa,” “la anestesia donde lo duermen completamente y una máquina controla la respiración.” The distinction patients need: “con la sedación, usted respira solo; con la anestesia general, la máquina respira por usted.”

AV fistula: “fístula arteriovenosa,” “el acceso,” “la comunicación entre la arteria y la vena.” Maturation: “maduración del acceso,” “desarrollo del acceso,” “el acceso está creciendo.” Thrill (fistula vibration): “el zumbido,” “la vibración,” “la sensación de movimiento de sangre.” Bruit: “el soplo,” “el ruido de la sangre.” Compression exercises: “los ejercicios de apriete,” “apretar la pelota,” “ejercitar el brazo del acceso.” Cannulation: “poner las agujas,” “usar el acceso para la diálisis.”

Embolization: “embolización,” “el procedimiento para bloquear los vasos sanguíneos que alimentan los miomas.” Uterine fibroids: “miomas uterinos,” “fibromas,” “miomas.” Uterine fibroid embolization (UFE): “embolización de miomas uterinos,” “embolización uterina.” Post-embolization syndrome: “el síndrome posterior a la embolización,” “la reacción normal después del procedimiento — dolor en el bajo vientre, fiebre baja, cansancio.” Femoral access site: “el punto de acceso en la ingle,” “donde le pusieron el catéter.” Hematoma: “hematoma,” “morete,” “sangre acumulada bajo la piel.”

The two questions that find the real pain score when a Spanish-speaking post-procedure patient is underreporting

The standard pain scale question — “¿cuánto dolor tiene del cero al diez?” — asks the patient to report her experience. It produces the number that reflects the experience she wants to have, not always the one she is having. Elena answered four at three consecutive checks because four was the number that kept the plan intact. The two questions that find the real number:

(1) “Antes de preguntarle el número, quiero aclarar algo: el número que me dé no determina automáticamente si se va a casa o si se queda. Lo que necesito es el número real para poder darle el medicamento correcto. Si me da un número más bajo para irse antes, el medicamento no va a ser suficiente en casa — y el dolor va a estar disponible completo cuando se acabe. Ahora sí: ¿cuánto le duele con el respiro que está tomando en este momento?” Separating the disclosure from its perceived consequences, then anchoring the question to an actual physical moment — not an abstract average, but this breath — produces a report from experience rather than calculation.

(2) If the number still seems inconsistent with what the nurse observes: “Noto que lleva varias horas en la misma posición y que está respirando muy superficialmente. Cuando los pacientes hacen eso, generalmente es porque moverse o respirar hondo duele más de lo que han dicho. ¿Puede intentar tomar un respiro profundo ahora?” If she winces, declines, or holds her abdomen, the assessment is done. Then: “¿Hay algo que le preocupa sobre lo que pasa si me dice el número real?” This is the question that surfaces the fear — discharge timing, overnight stay, the plan that depends on leaving — and opens the conversation to address the actual constraint rather than working around it.

The three patterns in this post — the sedation that was understood as something it was not, the protection instruction that crowded out the exercise instruction, the pain score calibrated to a discharge plan rather than an experience — share the same structure as every other gap in this library: information the clinical team held and did not transfer in a way the patient could use, combined with a patient whose behavior made complete sense from inside the information they actually received.

Antonio had not misunderstood sedación carelessly. He had understood it precisely, through the only anesthesia experience he had. Carmen had not skipped the exercises out of laziness. She had prioritized protection because protection was the word she had been given. Elena had not invented a four to manipulate the system. She had invented a four because four was the only number she could report from inside the situation she was in.

The conversations that close these gaps are not significantly longer than the ones they replace. They ask something different: not whether the patient understands, but what the patient understands. Not whether there is pain, but what number comes up when the breath is actually taken. Not what the patient is protecting, but what they believe protection means. Description, not confirmation. Demonstration, not assertion. The question that finds out, rather than the question that checks a box.

Download the free 50 essential phrases PDF for the phrases that come up in procedural units on every shift.

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